Budgeting / Cash Flow

A Life Aloft said:
Whaaaattt? Jesus, you are pathetic. You're just some kid who thinks he's the world authority on every subject on the planet......what the hell would you know about being a man? I re-read what I wrote and wanted to add something. I did that in like a minute. Since when the hell is that a crime around here? I corrected one typo too. Has that pissed you off as well? I was going to add that all states have programs for low income or for those in dire financial difficulties too, but I decided why bother. I didn't reply until now because we went to brunch. I didn't realize according to your rules, I had to stay here and waste more time with you. You just are obviously not worth trying to have any dialogue with.
Click to expand...

Man you really flip out easily. "Pathetic," "just some kid?" I must have struck a nerve with this too.

The ferocity of your reply has convinced me I was right in my assessment.
 
thegriffinpages said:
I currently have United Healthcare.

This past summer I went to the ER with a Gallbladder Attack, and a week later had Gallbladder Removal Surgery.

I'm fortunate I had insurance as I had MOST of it covered, but still had to pay some out of pocket.

Had I not had insurance, I would have owed 50K (ish).
Click to expand...
I'm surprised UHC didn't try to call that an "elective surgery."

Sent from my XT1650 using Tapatalk
 
@Bear. WTF is the actual topic of your post? Are you looking for advice? Want to know something specific? Just being you?

@A Life A Loft. We chatted a lot when I was more active here. I think we tend to agree on most things. Letting others bother you isn’t worth it.

@ppragman. You’ve got a ton of great experiences in your life. I envy some of the flying you’ve done. I’ll ask you this question: other than medical bills, is there anything that you’d recommend someone take first with the intention of negotiating a reduced price after you already posess it?

I’m not judging anyone for their beliefs, but I’m trying really hard to understand some things.

FWIW, I’ve had open heart surgery, cancer, dislocated a shoulder, a ventral hernia repair, and half my thyroid removed.

All were covered by insurance that I paid the deductible on. I don’t make (and never have made) $100,000 per year or more.
 
Bear said:
Great to see you had the coverage, that millions do not .


So you're on your parents plan! A real plus for many under 26.

https://www.cms.gov/cciio/resources/files/adult_child_fact_sheet.html

Young Adults and the Affordable Care Act: Protecting Young Adults and Eliminating Burdens on Families and Businesses

The Affordable Care Act allows young adults to stay on their parents’ health care plan until age 26. Before the President signed this landmark Act into law, many health plans and issuers could and did in fact remove young adults from their parents’ policies because of their age, leaving many college graduates and others with no insurance.
Click to expand...
Never said I was on my parents plan....
 
trafficinsight said:
I'm surprised UHC didn't try to call that an "elective surgery."

Sent from my XT1650 using Tapatalk
Click to expand...

All I know is that I’m glad I got that thing out. My surgeon said that I should have had the emergency surgery when I went to ER the first time instead of scheduling it for a week later.

It’s all water under the bridge now anyways except for a bit I have left to pay.
 
thegriffinpages said:
All I know is that I’m glad I got that thing out. My surgeon said that I should have had the emergency surgery when I went to ER the first time instead of scheduling it for a week later.

It’s all water under the bridge now anyways except for a bit I have left to pay.
Click to expand...
Yeah your gall bladder can be ruthless.

Sent from my XT1650 using Tapatalk
 
trafficinsight said:
Yeah your gall bladder can be ruthless.

Sent from my XT1650 using Tapatalk
Click to expand...

Man, it was unlike any pain I’ve ever felt!

Woke up around 1am that night not feeling right in the stomach. Vomited for a couple hours and was in SO MUCH PAIN! Decided to go to ER (worried about hydration).

Did a bunch of tests. Surprise you are having a Gallbladder Attack!

Took me three rounds of hard narcotics to manage the pain.

Go some scripts and sent home with referral.

Surgeon told me post op that I was not long from having that thing rupture inside me and that would have been nearly fatal.
 
TC_ABM said:
@ppragman. You’ve got a ton of great experiences in your life. I envy some of the flying you’ve done. I’ll ask you this question: other than medical bills, is there anything that you’d recommend someone take first with the intention of negotiating a reduced price after you already posess it?
.
Click to expand...

not that I can think of off hand? At least nothing that's not contrived? Regardless, medical care is different for multiple reasons.

See, it's different with medical care - especially if you are in no state to consent to treatment. Regardless even if you are cogent and of sound mind, you're always consenting under duress. "Let's see, $90,000 in debt or die...hmmm, maybe I'll just die."

It's like this, If you were dying of poison, and I had the antidote, would you say, "well, how much is the antidote?" No - you say, "give me the freaking antidote so I can live," then you figure out the price later. That's the thing, you're never able to make healthcare pricing considerations with the same level of information you might have when purchasing a car, or buying a plane ticket, or going to the grocery store. Even insurance is a bit of a gamble, because in America, insurance is tied through the employer for the vast majority of people. It's not like the average person has a whole ton of choice, and the insurance companies generally (with some exceptions) form an oligopoly.

Obviously, this is different for elective surgery - but for anything elective, you know the prices well in advance.

Beyond that, if you purchased a car and signed on the dotted line, then told the dealership that you "weren't going to pay as much" and started paying a lower bill you'd get your car repo'd. They can't repo your life. It's a different scenario because all goods and services are not equally fungible.

Though on the other side of the coin, I can surmise of an event that happens. I sell my employer my labor. If my employer decides they want to pay me less, in theory (as long as they tell me in advance) they could cut my pay. Which is roughly analogous and happens all the time either directly with pay cuts, or indirectly with "why don't we just schedule Bob for 30 hours this week." In this situation, I'd tell them, "sorry, I quit" and be on my way if I felt stiffed, but hospitals can't do that - for life saving care they have a legal duty to provide care whether the patient can pay or not. So again, it's a little bit different of a scenario.

Regardless, at the end of the day, it's really important to remember to look out for yourself - no one else is going to. The hospital doesn't care about you. You are just a number with a positive or negative balance in a patient database somewhere. If you're looking at crippling debt associated with something health related, not paying is absolutely a valid financial survival strategy. What's more important to you? The hospital getting their check? Or your kids not growing up in poverty? With decent insurance this is largely a moot point, but if your insurance isn't exactly great, or you live in a state where insurance companies are raising rates and reducing services, this might be a safer option than trying to struggle through a payment plan that's outrageous.
 
ppragman said:
not that I can think of off hand? At least nothing that's not contrived? Regardless, medical care is different for multiple reasons.

See, it's different with medical care - especially if you are in no state to consent to treatment. Regardless even if you are cogent and of sound mind, you're always consenting under duress. "Let's see, $90,000 in debt or die...hmmm, maybe I'll just die."

It's like this, If you were dying of poison, and I had the antidote, would you say, "well, how much is the antidote?" No - you say, "give me the freaking antidote so I can live," then you figure out the price later. That's the thing, you're never able to make healthcare pricing considerations with the same level of information you might have when purchasing a car, or buying a plane ticket, or going to the grocery store. Even insurance is a bit of a gamble, because in America, insurance is tied through the employer for the vast majority of people. It's not like the average person has a whole ton of choice, and the insurance companies generally (with some exceptions) form an oligopoly.

Obviously, this is different for elective surgery - but for anything elective, you know the prices well in advance.

Beyond that, if you purchased a car and signed on the dotted line, then told the dealership that you "weren't going to pay as much" and started paying a lower bill you'd get your car repo'd. They can't repo your life. It's a different scenario because all goods and services are not equally fungible.

Though on the other side of the coin, I can surmise of an event that happens. I sell my employer my labor. If my employer decides they want to pay me less, in theory (as long as they tell me in advance) they could cut my pay. Which is roughly analogous and happens all the time either directly with pay cuts, or indirectly with "why don't we just schedule Bob for 30 hours this week." In this situation, I'd tell them, "sorry, I quit" and be on my way if I felt stiffed, but hospitals can't do that - for life saving care they have a legal duty to provide care whether the patient can pay or not. So again, it's a little bit different of a scenario.

Regardless, at the end of the day, it's really important to remember to look out for yourself - no one else is going to. The hospital doesn't care about you. You are just a number with a positive or negative balance in a patient database somewhere. If you're looking at crippling debt associated with something health related, not paying is absolutely a valid financial survival strategy. What's more important to you? The hospital getting their check? Or your kids not growing up in poverty? With decent insurance this is largely a moot point, but if your insurance isn't exactly great, or you live in a state where insurance companies are raising rates and reducing services, this might be a safer option than trying to struggle through a payment plan that's outrageous.
Click to expand...

Thanks for this. I just learned a heck of a lot from this thread!
 
@ppragman thanks for helping me better understand your position. I think where we differ is the concept of consent.

Since this topic started around financial advice, here’s how I look at it. Most of the advice I’ve received is around the concept of financial security or financial readiness...that is, how does one protect themselves and their assets from a catastrophic loss.

In the health insurance case, I firmly believe this lies in having health insurance and knowing what is covered by your policy. It may mean having a high deductible plan with an HSA associated, an ACA plan, or membership in an association-based plan, but definitely not foregoing health insurance entirely.

Here’s why: Most people I know wouldn’t plan to have a heart attack; but hey, it happens.

If you have insurance and have savings for the deductible, you’ve protected your financial security both immediately, and to adjust to life after the heart attack.

With the path you suggest, you get the treatment and then refuse to pay. In negotiating with the hospital, what they’re willing to accept for payment is beyond your means, or you think it’s to high, because you’re looking out for you. That’s okay, but In doing so, the hospital has the right to sue you for a judgement if they believe you have the assets available that could be liquidated, or turn it over to collections, who will continue to chase you until you settle. Either way, there’s still a bill to pay. Yes, it may be pennies on the dollar, but in the bigger picture the choice to be uninsured results in an increased risk to your financial security.

How does this tie into consent? Well, if you can’t consent to the heart attack, when you choose to seek treatment, you are consenting to pay for that treatment. If you don’t want to consent to the cost, then I would argue that you shouldn’t seek treatment.
 
TC_ABM said:
@ppragman thanks for helping me better understand your position. I think where we differ is the concept of consent.

Since this topic started around financial advice, here’s how I look at it. Most of the advice I’ve received is around the concept of financial security or financial readiness...that is, how does one protect themselves and their assets from a catastrophic loss.

In the health insurance case, I firmly believe this lies in having health insurance and knowing what is covered by your policy. It may mean having a high deductible plan with an HSA associated, an ACA plan, or membership in an association-based plan, but definitely not foregoing health insurance entirely.

Here’s why: Most people I know wouldn’t plan to have a heart attack; but hey, it happens.

If you have insurance and have savings for the deductible, you’ve protected your financial security both immediately, and to adjust to life after the heart attack.

With the path you suggest, you get the treatment and then refuse to pay. In negotiating with the hospital, what they’re willing to accept for payment is beyond your means, or you think it’s to high, because you’re looking out for you. That’s okay, but In doing so, the hospital has the right to sue you for a judgement if they believe you have the assets available that could be liquidated, or turn it over to collections, who will continue to chase you until you settle. Either way, there’s still a bill to pay. Yes, it may be pennies on the dollar, but in the bigger picture the choice to be uninsured results in an increased risk to your financial security.

How does this tie into consent? Well, if you can’t consent to the heart attack, when you choose to seek treatment, you are consenting to pay for that treatment. If you don’t want to consent to the cost, then I would argue that you shouldn’t seek treatment.
Click to expand...


It is much more complicated than this. The hospital can sue you - but likely won't. It's far more complicated than that, and most of the time anyone threatening a lawsuit is from a debt collector and not the hospital anyway. Regardless, by sticking to your guns, you can likely settle for a much more financially plausible number. For instance, if three payments of $2000 is too high, let em' sit on it for awhile and come back with $50/mo for 10 years. They'll take it, and it won't mess up your cashflow so much.

Read this Quora post for more info:

https://www.quora.com/Can-a-hospital-sue-you

Also - you can't always "choose to seek treatment." If you get hit by a bus and are unconscious when you are brought to the ER, you didn't choose anything. Also, "choosing" to be treated for a heart attack isn't really a choice. If someone says, "give me all your money or I'll shoot you," is that really a choice?

You must look out for yourself in the medical system. If you've never been involved in it, you probably don't know how painful those bills can be.
 
@ppragman. While I agree that you must look out for yourself, I believe that responsibility begins with appropriate insurance coverage. I come to that belief because it’s worked for me and it’s a cornerstone of my overall financial readiness.

I respect that your experiences have shaped your position and I’m not going to try to convince you otherwise.

I do find the value in sharing experiences and opinions, thank you for sharing yours with me.
 
TC_ABM said:
@ppragman. While I agree that you must look out for yourself, I believe that responsibility begins with appropriate insurance coverage. I come to that belief because it’s worked for me and it’s a cornerstone of my overall financial readiness.

I respect that your experiences have shaped your position and I’m not going to try to convince you otherwise.

I do find the value in sharing experiences and opinions, thank you for sharing yours with me.
Click to expand...

So in my particular case, I changed jobs, bought gap insurance, and got unbelievably sick. Not anyone's fault. There was no way I could have "seen this coming" and the end result was bills we're still paying off a year later. Granted, we're going to be fine, and I am paying them, but if it would have been "oh I need chemo therapy and surgery" which was a distinct possibility when I first went in to get checked out...well, it would have been different, and instead of insurance getting most of the bill and me being on the hook for $5k, I'd have been on the hook for $100k, I would have fought that tooth and nail so I could make sure I could feed my kids and keep a roof over my head. Paying the hospital their "cut" probably wouldn't have been an option. "Ok, you'll get $40/mo for the next 208 years" probably would have been all I could do at the time.

My buddy's wife just had cancer. It was atrocious, she'll live, and everything is "ok" for now...but yeah...him getting slammed with well over $100k in fees for something he didn't plan on after his insurance (which was kind of crappy to begin with) paid is nonsense. You can be "responsible" do everything "right" and still get handed a crap sandwich - as was his case. For that reason, I recommend negotiation.

It's not the same as buying a house, or a car, or anything of that nature - in those scenarios, I'd even suggest that getting a product, using it, then demanding some of your money back would be unethical - still, with medical bills, I can no longer agree. No one chooses illness and you can do everything "right" and still get screwed. It's not "consensual" in any sense of the word. It's not like you have choice in most communities, and the nature of healthcare forces monopolies. There's no good "free market" solution to this that doesn't have terrifying downsides (like turning away dying people because they're not insured).

http://money.cnn.com/2017/10/25/pf/insurance/las-vegas-shooting-health-care/index.html

Take a gander at this stuff about the Vegas shooting. This could literally bankrupt people - even people with insurance. How can you be sure the ambulance that pulls your unconscious butt out of the mangled car wreck where the drunk hit you takes you to an "in-network" hospital? Obviously, the right answer is "get awesome insurance" but for millions of people that's not really an affordable answer, and even when I did have "awesome insurance" (by my part 135 standards) it didn't cover every hospital. When my kids had gotten sick and my wife took my son to the hospital several years back there was no "in network" hospital, and we paid out the nose. Not really anyone's fault - the insurance companies and hospitals are just trying to protect themselves too, but you cannot and should not feel an ethical duty to pay in certain circumstances.

When my adventures in healthcare started, I had about $10k in cash to spend on stuff just "lying around" and a reasonable amount in savings. After several months off work and doctor's bills where my copay was $1000...well, that went away quick. It could happen to everyone and anyone, and it's really easy to say, "pay your debts" until you see an unexpected $15,000 bill. If I didn't have my poop-in-a-group before all this and some family to lean on, we'd have been homeless. It's that simple.

In short, take care of yourself and your family's cashflow needs first, then contribute to the hospital's pocketbook.
 
You must log in or register to reply here.
Back
Top